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Icon: Multifaceted InterventionsMultifaceted Interventions: Accident & Emergency Fallers

Davison, et al.

This multifaceted intervention was designed for people who fell repeatedly. Participants received a medical fall risk assessment by a geriatrician at the hospital and had in-home assessments by physical and occupational therapists. Each participant received an individualized intervention designed to reduce their fall risk factors.

After 12 months, the fall rate in the intervention group was 36 percent lower than the rate in the comparison group.

Population

Participants were men and women aged 65 or older. All had experienced at least 1 fall in the past year and also had been treated in the emergency department for another fall or fall injury. About three-quarters of participants were female.

Geographic Locale

Newcastle, United Kingdon

Focus

Identify and modify each participant’s fall risk factors.

Program Setting

The medical assessment was conducted in a hospital and the physical therapy and home assessments were conducted in participants’ homes.

Content

After taking a medical and fall history, a physician conducted a full clinical examination that included vision, medication review, a neurological examination, and a cardiovascular assessment. Postural blood pressure was assessed and laboratory tests and an electrocardiogram were performed.

Interventions for identified fall risk factors followed recognized treatment recommendations. Each participant was referred to relevant specialists as needed, such as to an optometrist for vision correction or cataract removal; given advice or medication to reduce orthostatic hypotension; and had medications associated with falls stopped, reduced, or modified.

The physical therapist evaluated each participant’s gait and balance and, if necessary, provided gait re-education and the functional training program used in the Yale FICSIT (Frailty and Injuries: Co-operative Studies of Intervention Studies) study (See Koch, et al. and Tinetti, et al. under Supplemental articles). The main intervention was exercise to strengthen the proximal leg muscles and ankle dorsiflexion muscles. If needed, participants were given assistive devices, had their footwear modified or replaced, and were referred to a podiatrist.

An occupational therapist used a room-by-room environmental fall hazard checklist, the User Safety and Environmental Risks (USER) checklist, to identify potential hazards throughout the home including the kitchen, bathroom, bedroom, and stairs (See Hagedorn, et al. under Supplemental articles). Specific areas included the position and condition of furniture, cabinets and shelving heights, loose rugs and tripping hazards, grab bars and handrails, toilet height, and lighting (including the use of night lights).

Environmental interventions followed published criteria (See Tideiksaar under Supplemental articles) and included advice about reducing home hazards as well as suggestions for specific home modifications.

Duration

On average, participants visited the hospital twice for the medical intervention. The initial hospital assessment took 1 hour and the medical intervention visit was 20 minutes. Participants received 2 physical therapy intervention visits; the initial physical therapy assessment took 45 minutes and the intervention lasted 15 minutes. The occupational therapy visit took 45 minutes and the follow-up visit about 1 month later lasted 20 minutes.

Delivered by

A physician performed the medical assessments and made appropriate referrals to specialists; a physical therapist conducted the gait and balance assessment and re-education; and an occupational therapist conducted the home hazard assessment and recommended home modifications.

Minimum Level of Training Needed

This intervention requires a variety of highly trained health care professionals. Complex individualized interventions of this type cannot be implemented by individuals with lower levels of training.

Key Elements

Multifactorial assessments and interventions conducted by highly trained individuals in each of the 3 disciplines.

Available Materials

No additional materials are available.

Study Citation

Davison J, Bond J, Dawson P, Steen IN, Kenny RA. Patients with recurrent falls attending accident and emergency benefit from multifactorial intervention: A randomised controlled trial. Age and Ageing. 2005 Mar;34(2):162-8.

Supplemental articles

Koch M, Gottschalk M, Baker DI, Palumbo S, Tinetti ME. An impairment and disability assessment and treatment protocol for community-living elderly persons. Physical Therapy. 1994 Apr;74(4):286-94.

Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett, P, Gottschalk M, Koch ML, Trainor K, Horwitz RI. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. New England Journal of Medicine. 1994 Sept 29;331(13):821-7.

Hagedorn R, McLafferty S, Russell D. The User Safety and Environmental Risk Checklist (USER). In: Anonymous falls: Screening and risk assessment for older people in the community. Worthing Priority Care NHS Trust. 1998:48-57.

Tideiksaar R. Preventing falls: Home hazard checklists to help older patients protect themselves. Geriatrics. 1986 May;41(5):26-8.

Contact

Practitioners interested in using this intervention may contact the principal investigator for more information:

Dr. John Davison
Falls and Syncope Service and Institute for Ageing & Health
Royal Victoria Infirmary
Newcastle upon Tyne NEI 4LP, United Kingdom
Fax: (+44) 191 222 5638
E-mail: john.davison@ncl.ac.uk

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